HIV update - 15th November 2018

Viral load in semen after stopping treatment

Ten men were taking part in a study of a potential
therapeutic vaccine. They all had an undetectable viral load in both blood and
semen when they stopped taking their HIV treatment. For the next 12 weeks,
they provided blood and semen samples every two weeks, before re-starting their
HIV treatment.

Two weeks after stopping treatment, viral load had rebounded
to detectable levels in the semen of four men. Four weeks after stopping
treatment, it had rebounded in the semen of another four participants. The
semen samples were missing for the last two participants.

These levels were infectious (average 40,000 copies/ml). In
fact, an HIV transmission occurred from a study participant to his partner
during the treatment interruption phase of the trial.

The findings have clear implications for HIV treatment as
prevention, showing that viral load in semen can increase rapidly to infectious
levels during a break in treatment.

How would you like to take your treatment?

Researchers are interested in developing forms of HIV
treatment that don’t have to be taken so often. Injectable treatment that is
taken once a month might be available in the next few years and other options
are being worked on.

two injections in the clinic every other month:
39% were very interested.

a small plastic rod that could be implanted (and
removed) from the forearm, every six months: 18% were very interested.

The researchers point out that there is no one method which
appealed to everybody. People have a range of views about different options.

Two-drug protease inhibitor regimens

Another area of research is into HIV treatment regimens that
involve fewer drugs. In the last few years several studies have compared treatment
with two-drug regimens with three-drug regimens, each based on boosted protease
inhibitors. For example, a two-drug regimen could be darunavir (boosted with ritonavir)
taken with lamivudine. A three-drug regimen would also include another drug,
such as abacavir.

Pooling
the results of seven small studies, researchers found that the
two-drug regimens were just as effective. In addition, people taking the
two-drug regimens were less likely to need to change treatment because of side-effects.
The results were equally applicable for people taking treatment for the first
time and for people switching treatment.

New drugs for people with a lot of drug resistance

A recent conference heard about treatment options for people
whose HIV has resistance to most other anti-HIV drugs.

Ibalizumab (Trogarzo)
is a monoclonal antibody that attaches to the CCR5 or CXCR4 co-receptors on
cells and so stops HIV from infecting them. It is taken as an infusion (drip)
every two weeks, in additional to conventional HIV treatment. The 40 people who
took part in a recent study had very advanced HIV disease (median CD4 cell
count 73 cells/mm3), 90% had resistance to drugs in at least three
drug classes, and they had been living with HIV for a median of 23 years.

After 48 weeks, 15 of 40 people who started treatment with
ibalizumab had a viral load below 50 copies/ml. Ibalizumab is available in the
US and is being reviewed by European regulators.

Fostemsavir,
another drug for the treatment of drug-resistant HIV, prevents HIV
from attaching to CD4 cells by sticking to the virus, not the cell. It prevents
a change of shape of HIV’s gp120 protein that is necessary for it to lock on to
the CD4 receptor. As in the other study, the 371 people who took part in the
study had few treatment options left – their average viral load was around
40,000 copies/ml and three-quarters had a CD4 count below 200.

They took fostemsavir alongside other antiretroviral drugs.
After 48 weeks, 54% of people who were still able to use one or two other HIV
drugs had an undetectable viral load. Of individuals who could not have any
effect from other HIV drugs because of resistance, 38% had an undetectable viral load. Fostemsavir is
not yet licensed.

Getting help with depression and giving up smoking

The online programme was based on principles of cognitive
behavioural therapy. It was developed specifically for people with HIV and
encouraged participants to engage in pleasant activities, use relaxation
techniques, challenge negative thoughts, and set realistic, concrete goals. As
well as working through online modules for an hour or two a week, participants
got some telephone support.

People who were randomly assigned to the online programme
had a greater improvement in their symptoms of depression than people in the
control group. Anxiety symptoms were also decreased.

They offered weekly sessions based on cognitive behavioural
therapy that dealt with smoking cessation, anxiety and depression together, as
well as nicotine replacement therapy. Six months later, far more people who
received the programme were still not smoking (46%) than was the case for
people in the control group (5%).

Hepatitis C in rectal and nasal fluids

The findings reinforce the plausibility of hepatitis C
transmission through sharing of rolled-up bank notes to snort drugs. They also support
the hypothesis that hepatitis C can be passed on during anal sex, regardless of
whether there is any bleeding. A previous study showed that the virus can be
found in semen.

Gammora does not cure HIV

You may have read news headlines suggesting that a new drug
called Gammora “kills 99.9% of HIV” and “could offer a cure”.

Unfortunately,
this is not true. The study has not been presented at a scientific
conference or published in a peer-reviewed medical journal. The only
available information is a badly written press release, which announces results
that are no better than conventional antiretroviral therapy. What’s more, the
nine patients who took Gammora were also taking conventional antiretroviral
therapy.

“The HIV world has seen quackery in different forms for
decades – sadly this smacks of more of it,” Professor Francois Venter of the
University of Witwatersrand, South Africa commented. “This gives science and
scientists a bad name.”

Editors' picks from other sources

The
Home Office has abandoned a controversial “hostile environment” scheme
using NHS data to track down patients believed to be breaching
immigration rules.
In the face of a legal challenge brought by the Migrants’ Rights
Network, a memorandum of understanding between the Department of Health,
NHS Digital and the Home Office is being scrapped.

A
man who asked his local sexual health clinic for PrEP, the HIV
prevention drug, but who was denied it because the NHS has capped the
supply, was diagnosed as HIV positive just a few months later, BuzzFeed
News can reveal.

Patients should consider stockpiling their own drugs if it looks
likely the UK will leave the EU with no deal, the pharmaceuticals
industry has said, telling MPs that such a scenario could be
“catastrophic” for medicine supplies and necessitate emergency powers.

NAM’s information is intended to support, rather than replace, consultation with a healthcare professional. Talk to your doctor or another member of your healthcare team for advice tailored to your situation.

The Community Consensus Statement is a joint initiative of AVAC, EATG, MSMGF, GNP+, HIV i-Base, the International HIV/AIDS Alliance, ITPC and NAM/aidsmap

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This content was checked for accuracy at the time it was written. It may have been superseded by more recent developments. NAM recommends
checking whether this is the most current information when making decisions that may affect your health.

NAM’s information is intended to support, rather than replace, consultation with a healthcare professional. Talk to your doctor or another member
of your healthcare team for advice tailored to your situation.